Injuries round the patella

246

Injury,

7, 246-249

Abstracts Bacteriology Infection

after

and infection human

bites

Sixty-five patients with hand infections secondary to human bites were reviewed. The injuries were usually associated with fighting. Opening of the clenched fist produces deeper injury at different sites. The majority have two or more organisms present. Staphylococcus uureus, resistant to penicillin, is the most common. Forty-two separate organisms were isolated from the normal flora of the human mouth. Treatment should include early culture and dkbridement, tetanus prophylaxis and wide spectrum antibiotic. All wounds should be left open. SHIELDSC., PATZAKISM., MYERSM. and HARVEY J. jun. (1975) Hand infections secondary to human bites. Trauma 15, 235. Prevention of tetanus in the wounded Recommendations for the prevention of tetanus in the wounded have been revised to incorporate the use of human tetanus immunoglobulin, which is now available in the United Kingdom. Surgical toilet is of prime importance for all wounds, and is usually sufficient for tetanus prophylaxis in wounds that are less than 6 hours old, clean, non-penetrating, and with negligible tissue damage. Human tetanus immunoglobulin should be given to patients with more serious wounds who have had toxoid injections over 10 years earlier, had an incomplete course, or do not know their immunity status. The importance of active immunization is emphasized. The recommendations should be regarded as guidelines as the circumstances in individual cases will differ. SMITHJ. W. G., LAURENCED. R. and EVANSD. G. (1975) Prevention of tetanus in the wounded. Br. Med. J. 3, 453. Hospital

cross-infection

It seems that after severe trauma (as is the case with all severe illness) patients lose their defences against infection. Detailed studies of a series of patients admitted to a centre for the study of trauma confirm the suspicion that there is a high morbidity from pseudomonas, klebsiella, staphylococcus and candida. Evidence suggests that these are carried to the patients by means of the attending staff whose hands are often found contaminated by back infection.

Indwelling tubes such as tracheostomies and urethral catheters are frequent sites of infection. Instruments and equipment are not so suspect. The early and seemingly inevitable march of infections in these cases is well depicted. SCHIMPFFS. C., MILLERR. M., POLAKAVETZ S. and HORNICK R. B. (1974) Infection in the severely traumatized patient. Ann. Surg. 179, 352. Tetanus

in Haiti

The authors treated 985 patients (excluding the new born) with tetanus in the course of 15 years. Mortality rates ranged from 3 per cent in the absence of spontaneous convulsion, to 51 per cent when convulsion was severe. The mean mortality rate was 22 per cent. Having reduced the dose of antitoxin from 100,000 units they concluded that 10,000 units were enough and they had no case of allergic reaction to this dose. After trying several other drugs they came to rely on diazepam for sedation. The nursing was by suitably trained aides, not highly skilled nurses. Tracheostomy was reserved for those cases in whom the air passages could not be kept clear otherwise and particularly when hypoxia threatened to stop the heart; it was usually combined with gastrostomy. In the case of neonatal tetanus they used diazepam and 10,000 units of antitoxin but avoided tracheostomy and endotracheal intubation. They treated over 3500 cases and reduced mortality to 26 per cent. GARRIERM. J., MARSHALLF. M., DAVIDSONK. J. and LEPREAUF. J. (1975) Tetanus in Haiti. Lancei 1, 383.

Fractures Fracture

and dislocations of the scapula

Fifty-three patients with fractures of the scapula have been reviewed. Three-quarters were injured in road traffic accidents. Eighty-one per cent had other injuries, many of them serious. In 66 per cent the location was in the region of the scapular neck. Symptomatic splinting is adequate treatment. IMATANI R. J. (1975) Fracture of the scapula. Trauma 15, 473. Injuries

round

the patella

This editorial reviews current thought upon patella injuries and ends with the evaluation of Sanderson

247

Abstracts

(SANDERSONM. C. (1975) Amt. N.Z. J. Surg. 45, 40) on different forms of treatment. Those with conservative treatment had 83 per cent good to excellent recovery. Of those whose patellas were excised, 64 per cent did well despite some loss in power. Those with internal fixation resulted in only 55 per cent satisfactory response. Sanderson concluded that should there be doubt about treatment, then patellectomy would be the treatment of choice despite some inevitable loss of power. EDITORIAL(1975) Br. Med. J. 3,447. Traumatic dislocation of hip in children

This condition is not common: a total of 409 cases have been reported in the literature. In 13 of these patients the dislocation had recurred. The dislocation is almost always posterior. This paper presents a review of the reported cases and describes 600 additional cases, one of which recurred after minor trauma. The most common complication is ‘caput necrosis’ which occurs in 5-30 per cent depending on the age. The incidence is higher in older children. The correct treatment is closed reduction followed by a brief period of immobilization. Fracture of the posterior lip of the acetabulum is a rare complication. When present, open reduction and internal fixation may be necessary to restore stability. HOVELIUSL. (1974) Traumatic dislocation of the hip in children. Acta Orthop. Stand. 45,746. Degenerative

disease of hip

In a review of total hip replacements at one hospital, 80 cases were noted in which degenerative arthritis had been caused by injury, for example fractures of the neck of femur or acetabulum. The treatment, results and complications are described. WELCH R. B., TAVLORL. W. and WYNNE G. W. (1975) Total hip replacement as a salvage in traumatic lesions about the hip. Surg. Gynecol. Obstet. 140, 708. Fracture-dislocation joint

of the tarso-metatarsal

Nine cases of fracture-dislocation of the tarsometatarsal joint are presented and these vary in major details from simple dislocations due to head-on collisions in car accidents to ones where weights have fallen on the foot, and there are fractures involving the shafts of the metatarsal also. They recommend an operative approach, fixing the fracture with Kirschner wires temporarily, and had reasonable results in these cases. whereas in conservative management results have’ been disappointing. In late &es, primary tarso-metatarsal arthrodesis is suggested, especially when the joints are badly damaged. Simple dislocations without fracture are better treated conservatively and are mostly reduced without too much difficulty, though the foot is certainly stiff at the midtarsal joint afterwards. RINALDI C. A. (1975) Operative treatment of fracture-dislocation bf the tarso-metatarsal joint. Minerva Ortopedica 26, 323 (Italian).

Recreational

injuries

Ski injuries in the USA

There are 5 million skiers in America with an injury rate of 5 per 1000 skiing days. Such is the estimate of Dr Gutman who analysed 792 skiing injuries in the 1972-3 season in Vermont, and compared the statistics with those of the 12 years previously. Sprains accounted for nearly half of the injuries in both series. Ankle sprains were common in 1961, but the upper limb was more often involved in the later group. Likewise half the fractures in 1961 were situated in the ankle, whereas in 1973 this figure had dropped to 20 per cent, and there were three times as many fractures in the uouer limb in the later series. The author finds this change in the pattern of ski injury to be due to the use of hard plastic boots which protect the lower leg. The author also found an increase of injuries i% the more skilled skier and explained this on the basis of improvement in speed and a tendency to take more risks. GUTMANJ., WEISBUCHJ. and WOLF M. (1974) Ski injuries in 1972-73. JAMA 230, 1423. Hang glider injuries

The first report on injuries received by hang gliders includes 4 fatal cases and 8 serious non-fatal ones. outlines the factors responsible and suggests preventive safety measures. There are an estimated 10,000 participants in the United States in this new high-risk sport. Novices who become airborne by running down hill do not get seriously injured. Major injuries occur in launches from cliffs and mountains. Faulty judgement seems to be the commonest cause of serious injury, but there was one fatal accident due to the use of hallucinogens and one caused by equipment failure. Among the many suggestions for the prevention of hang glider accidents are special clothing and the use of helmets and ankle top boots. KRISSOFZW. B. and EISEMANB. (1975) Injuries associated with hang gliding. JAMA 233, 158. Treatment of sunburn

Topical application of indomethacin dramatically reduces redness and pain of sunburn. This is the claim of dermatologist Dr Snyden from Miami made to the American Academy of Dermatology meeting in Chicago. She used a simple organic solution of 2.5 per cent indomethacin. Similar results were obtained with 450 mg of neutralized aspirin injected intradermally. Both these drugs work by inhibiting enzymes that synthesize prostaglandin. These claims are based on tests with 30 animals and 25 humans. SNYDERD. (1974) Prostaglandin inhibitors heal subburn. JAMA 227,386. Pathology

and experimental

work

The myofibroblast

As well as normal fibroblasts in hypertrophic scars, contractile fibroblasts are recognized. There is some evidence that they could play a part in scar contraction